Ads-O-Matic Member Registration Form

Ads-O-Matic
P.O. Box 330
Arroyo Grande CA 93421 USA

FAX # 866-458-1575

Feb 5 2012
10000

To sign up via mail or fax, please fill out the fields below, then click the "print" button at the bottom of this page. Then mail it along with your check or money order for $99, or credit card information, to the address above. If you'd prefer, you may also fax this registration form along with your credit card information to us anytime, toll-free FAX # 866-458-1575

Once we receive your order form and payment, your account will be activated and you'll receive access information via email within 24 hours. Please be absolutely certain that your email address listed below is correct. All members are bound by our Terms and Conditions so be sure to read them. Thanks!

Company Name:
Full Contact Name:	Example: John Doe
Email Address:	Example: you@isp.com
Phone Number:

Street Address:
City or Town:
State or Province:
Zip or Postal Code:
Country:

Select A Password:	Note: Must be between 4 and 10 letters and/or numbers!

Payment Type:

Name On Card:

Credit Card Number:

Expiration Date:

3 Digit Card Number:

		on back of card

Signature:

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